Pituitary Adenoma Presenting as Cranial Nerve III Palsy and Hemifacial Pain

Pituitary adenomas are common neoplasms arising from the pituitary adenohypophyseal cell. They can be classified by cell type, size and as nonfunctioning or functioning based on the secretion of pituitary hormones. Of these, approximately 48% are macroadenomas (>10 mm) and approximately 53% are prolactinomas. For how common these adenomas are, only 1 of 1100 persons manifest clinical symptoms1 rendering detection and clinical management challenging. Non-functioning adenomas are slow growing like most pituitary adenomas and are usually detected due to their mass effect on neighboring structures.2 The majority of the reported symptoms as a results of these mass effects are visual field defects and headaches.3 This is usually due to a superior expansion and thus compression to the optic chiasm. In rare instances, inferior expansion, and or cranial nerve palsies have been reported.4 We present the case of an 80-year-old patient with a pituitary macroadenoma with cavernous sinus extension who presented with CN III palsy and hemifacial pain.